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Advisory Board on Radiation and Worker Health 

Findings for Dose Reconstruction Review Cases Sets 6-13 (Cases No. 101-334) 

and Comparisons to the First 100 Dose Reconstruction Review Cases

(Report prepared by the Subcommittee on Dose Reconstruction Reviews)

September 2015

FINDINGS

(Part A) This is a summary report to the Secretary of Health and Human Services with respect to 

the Advisory Board's independent review process of radiation dose reconstructions completed by 

the National Institute for Occupational Safety and Health (NIOSH) as required by the Energy 

Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA). The purpose 

of the Board’s review is to advise the Secretary on the “scientific validity and quality of dose 

estimation and reconstruction efforts being performed for purposes of the compensation 

program”. The Board feels that interim reports, such as this one, may be useful in affecting 

change in the methods, procedures, or policies of the NIOSH dose reconstruction program while 

the overall review continues. 

Cases Sent to NIOSH for Reconstruction 

As of November 1, 2015 DOL reported a total of 44,789 total case claims sent to NIOSH, of 

which 42,714 cases (95.4%) had already been returned to DOL with a compensation 

recommendation, with the remaining 2,075 (4.6%), both new and returned, at NIOSH . The 

42,714 cases returned included both dose reconstructions and Special Exposure Cohort (SEC) 

cases compensated due to inability to estimate the radiation dose with sufficient accuracy and 

reasonable likelihood of health endangerment. (Administratively some of the latter cases were 

processed by NIOSH while and until the SEC classification was determined, and others directly 

by DOL if and after the SEC class was approved.) 

Types of Dose Reconstruction

The cases reconstructed since the Board’s inception fall into three basic types: 1) ‘best estimate’ 

dose reconstructions; 2) ‘over-estimated’ dose reconstructions: and 3) ‘under-estimated’ dose 
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reconstructions. NIOSH’s overestimating approach is an efficient way to process claims which 

are non-compensable. This time saving method is only intended for non-compensable claims. 

Under-estimation is also a time saving approach used for claims that are compensable. Since the 

claims are compensable a more precise estimate of dose is not necessary. The best estimate 

approach is used for cases that are not clearly compensable or non-compensable, and gives the 

most precise estimate of dose in order to make a decision on compensation. [Note that dose 

reconstructions are not undertaken for claims in facilities approved for SECs. In claims for 

facilities with SECs for which the cancers declared are not among the 22 covered for SECs under 

EEOICPA, a partial dose reconstruction may be undertaken.] 

Dose Reconstruction Cases

At the conclusion of the dose reconstruction reviews for Sets 6-13, which is the focus of this part 

of the report, NIOSH’s Division of Compensation Analysis and Support (DCAS) reported a total 

of 31,534 claims with completed dose reconstructions sent to the Department of Labor. The 

remaining recommendations were primarily Special Exposure Cohort (SEC) cases, but also 

included some cases returned to DOL for administrative reasons. The distribution of types of 

dose reconstructions (DRs) for these claims, made since the inception of DCAS in 2001, is as 

follows (Table 1): 

Table 1. Types of Dose Reconstruction for the First 31,534 DRs* 

Best Estimate Over-Estimate UnderEstimatePartial

2,452 (7.8%) 18,960 (60.1%) 8,104 (25.7%) 2,018 (6.4%)

 * Completed as of Nov. 1, 2015. 

Thus a majority of the claims submitted involved over-estimated dose reconstructions, and an 

overwhelming majority (85.8 percent) either over- or under-estimates. Only 7.8 percent required 

the more precise and more time-consuming best-estimate DRs. Partial dose reconstructions 

comprised the remaining 6.4 percent. Also 13.4 percent of the claims were made by female 

employees. No data were collected on race or ethnicity of the claimants except for those filing 

for skin cancers, for whom differences in incidence rates by race were taken into account. 
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Dose Reconstruction Cases Reviewed

Of the dose reconstruction cases reviewed for this report (Cases No. 101-334), the Dose Reconstruction 

Reviews Subcommittee, with technical assistance from NIOSH/DCAS, its subcontractor ORAU (Oak 

Ridge Associated Universities) and the Board’s contractor (Sanford Cohen and Associates – 

SC&A), has been able to undertake more reviews of best-estimate dose reconstructions. 

Although best-estimate dose reconstructions are relatively infrequent under the NIOSH program, 

they are particularly important in that errors could potentially result in DOL making incorrect 

compensation decisions. Also best estimates require much more sophisticated machinery, more 

complete records and more difficult professional decisions to bridge information gaps both 

reasonably, claimant favorably, and plausibly. Hence best estimates test the dose reconstruction 

process more effectively and intensively. 

Of the recently reviewed Cases 101-234, 193 (82%) were best estimates, 32 (14%) were overestimated and 7 (3%) were under-estimated. [Two cases in Sets 6-13 have not yet been reviewed 

pending updates of their site profiles by other working groups.] Thus a total of 17% were either 

over- or under-estimated. These results stand in sharp contrast to the results from our Report on 

the first 100 cases reconstructed, where only 7 percent were best estimates and 93 percent either 

over- or under-estimates. (Table 2) 

Table 2. Types of Dose Reconstruction

Report Best Estimate Over-Estimate UnderEstimateNot 

Completed

First 100 Cases (2009) 7 (7%) 76 (76%) 17 (17%) 0

Cases 101-334 (2015) 193 (82%) 32 (14%) 7 (3%) 2 (1%)

The reconstruction of the first 100 cases largely through over- and under-estimates reflected the 

imperative to rapidly process the large initial batch of claims under EEOICPA and eliminate the 

resulting case backlog. As the program has matured, 

• The backlog of individual claims has now been reduced so that about as many individual 

cases as are sent to NIOSH quarterly are processed during that quarter. 
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• Many site exposure profiles for covered facilities have been completed based on site 

visits by staff and Board members and the establishment of 37 different site-specific 

Board Work Groups, 

• Many more analytical procedures have been written down based staff input and the 

activities of the Board’s Procedures Review Subcommittee so that dose reconstruction 

decisions are now better regularized and more nearly uniform. 

Thus since 2009 the Dose Reconstruction Reviews Subcommittee (DRSC), with the aid of staff 

from NIOSH, subcontractor ORAU (Oak Ridge Associated Universities) and independent 

consultants SC&A (Sanford Cohen and Associates), has been able to undertake under Board 

guidance best-estimate dose reconstruction reviews for more than four-fifths of the next 232 

completed dose reconstructions. 

Findings among Reviewed Cases 

In examining the 234 cases from Sets 6-13, the Dose Reconstruction Reviews Subcommittee 

reviewed a total of 670 findings (2.86 per case) in which there were initial differences between 

the dose assessments for individual cases made by the NIOSH and ORAU staffs and those made 

by the SC&A consultants. These were then discussed first by the staffs of the respective groups 

and later reviewed by the full Dose Reconstruction Review Subcommittee. Of the 670 findings, 

550 (82%) were found to be of low impact, 98 (15%) had a medium impact, and 22 (3%) had a 

high impact. [The four findings from the 2 cases not completed were assigned their original 

finding rank.] 

A finding is found to have a low impact if it has only a marginal impact on the compensation 

decision, involving for example a minor QA concern, a minor clarification, or a change in dose 

(increase or decrease) of only a few millirems (mrem). A finding is found to be medium impact 

if it was related to some change in procedures, a more involved discussion or clarification of the 

DR methods, or involved a change in dose of mrem to rem quantities. A finding is found to be 

high impact if it prompted a major change in procedures that would affect several cases, or if it 

involved a change in assigned dose of several rems. As a result of discussion and review of these 

findings the probability of causation was changed in only ____ cases, resulting in the 
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compensation of a claimant who was initially denied such compensation. [NOTE: An important 

number, perhaps as few as 3 cases, but the precise criteria for which have not yet decided by the 

DRSC. Further discussion of this issue is on the agenda for the Feb 10 DRSC meeting.] 

As might be expected, the above result of 2.86 deficiencies per case is 28 percent than the 3.98 

per case reported in 2009. However the distribution of impacts in this report (82%L, 15%M and 

3%H) is quite similar to those in the 2009 report (86%L, 12%M and 3%H) . While this result 

might at first appear anomalous, it may reflect the facts that the dominant over- and underestimations in the first report were broad assessments, not likely to present major errors, whereas 

for this report, dominated by best estimates, the chances for errors are far greater, but due to 

improved assessment procedures and protocols the percentage of high-impact findings has been 

kept low – that is, these two effects have had counteracted each other to keep the percentage of 

high-impact findings low. 

In addition to assessing the degrees of impact for deficiencies for each case reviewed, the DRSC 

guided by input from NIOSH, ORAU and SC&A and approved by the Board began in Set 6 to 

assess and categorize findings by type of issue or issues involved in these deficiencies. The types 

of issues and their distribution among findings for Cases 101-334 are presented in Table 3. 

Table 3. Findings by Type of Deficiency for Cases 101-334* 

Category Type of Deficiency Nr. Of Findings

A Was the proper judgment made regarding placing a 

person physically at a work location? 

16

B Were all exposure scenarios considered (i.e., neutron, 

thorium)?

33

C Were the correct external dose model and assumptions 

used?

270

D Were the correct internal dose model and assumptions 

used?

143

E Is it a quality concern? 98

F It does not meet either of the above criteria. 114

 Total 674*

*NOTE: Some cases had more than one type of deficiency. 

As is clear from this Table, the greatest source of findings (40 percent) is disputed modeling or 

assumptions about external doses, followed by the same (21 percent) for internal doses. The 
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former often reflects different information between NIOSH and SC&A about radioactive 

materials present at a site. If a discrepancy is found in a reviewed case on the part of NIOSH, all 

cases, present and former, are re-run by NIOSH and non-compensation decisions reversed when 

appropriate. Dose reconstructions related to internal doses are quite complex and thus the reasons 

for discrepancies between NIOSH and SC&A are quite varied, but again if after review and 

subcommittee discussion if a discrepancy is found on the part of NIOSH all affected cases in that 

and other similar facilities are re-run aand appropriately compensated.

Observations among Reviewed Cases

In addition to the findings under review, SC&A consultants also made 206 observations (slightly 

less than one per case reviewed). Observations, which began being noted and recorded in Set 8, 

are instances where SC&A had questions about NIOSH/ORAU dose assessments which were 

discussed by the parties and reviewed by the DRSC to confirm that proper procedures were 

followed and applied correctly. If not confirmed, the instances initially assessed as observations 

were changed to findings and re-examined as appropriate. Thus none of the 206 observations 

recorded resulted in a change of dose assessment. 

Number of Dose Reconstruction Cases Reviewed 

The Dose Reconstruction Reviews Subcommittee has reviewed 334 cases since its inception

among the 31,534 claims filed as of Nov. 1, 2015 which required dose reconstructions. Thus this

Subcommittee has completed reviews of 1.06 percent of all such claims filed as of this date, 

achieving its current goal of 1% of all claims reviewed involving DRs. Initially the DRSC and 

the Board had set a goal of 2.5% of all claims reviewed, as reported to the Secretary in 2009, 

reflecting our experience of conducting reviews 93 percent of which were over- and underestimates. But since 2009 the DRSC has greatly increased the percentage of best-estimate 

reviews to 82 percent from 7 percent (Table 2). Such best-estimate reviews, while more 

extensive but also more time-consuming, have necessarily slowed down the Program’s pace of 

reviews. At that time the Board approved reducing our goal to 1 percent of DR cases to be 

reviewed and this goal has been met. The Board and the DRSC fully expects to continue meeting 

this goal during the next operational period. [Note to Board members: At earlier Board meetings 

and in the first draft of this report, I announced that we had achieved only 0.86% reviewed. 
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Grady recently sent me the total nr of DRs conducted since our inception, and this is much less 

than the total the program has processed, which I had used in the past (which unwittingly 

included SECs). When I used Grady’s nr in the denominator, the percentage shot up to 1.06%.] 

Distribution of Dose Reconstruction Sites across Employment Sites

In addition the DRSC has worked assiduously since 2009 to assure that cases selected for review 

represented an appropriate cross-section of all the plants and facilities for which compensation 

claims have been made. The breakdown of employment sites covering cases 101 through 334 is 

presented in Figure 1. (Copy Figure 1 from revised Summary Statistics, Rose Gogliatti, SC&A, 

January 7, 2016.) As indicated in this Figure many small sites were covered by 64 of the cases 

reviewed – 38 from sites with one reviewed case and 26 from sites with two cases reviewed. 

These reviewed cases reasonably well cover the array of claims filed under EEOICPA. In Figure 

2 (Copy Figure 3 from revised Summary Statistics, Rose Gogliatti, SC&A, January 7, 2016.) the 

blue bar next to each of the 26 large and medium sites represents the number of cases needed to 

be reviewed in order to achieve our goal of 1% of all claims reviewed for that site. The second 

bar next to each site is the sum of cases which have been reviewed, combining those for Cases 1-

100 (in brown) and those for Cases 101-334 (in green). Thus if the height of the brown-green bar 

for the reviewed exceeds that of the blue bar, then the Board has accomplished its goal of 1% of 

claims reviewed for that site. 

As noted in Figure 2, of the 26 sites listed the DRSC has met or exceeded its one-percent goal for 

11 of them and has not met its goal for 15 sites. However six of the 15 are large sites with 15 or 

more reviews needed. These six sites represent about 80% of the reviews needed for the 15 

deficient sites and all six are within 25% of the 1% goal. The remaining nine sites represent only 

about 20% of the reviews needed and all are smaller sites, with less than 15 reviews needed. For 

these nine sites the DRSC has conducted only 43% of the reviews needed. For sites with very 

small numbers of claims (Figure 2, bottom line) the DRSC has far exceeded its goal, with 82 

reviews completed when 53 were needed, more than 50 percent greater than its one-percent goal. 

The deficiencies at the 15 large and medium sized sites can readily be corrected through a focus 

on selecting and reviewing cases from these sites during the next review period.
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Distribution of Probabilities of Causation among Cases Reviewed

The chart in Figure 3 (Copy Figure 7 from revised Summary Statistics, Rose Gogliatti, SC&A, 

January 7, 2016.) shows the distribution of Probabilities of Causation (POC) among cases 

reviewed in Sets 6-13 (Cases 101-334). Cases with POC between 45-52% have been targeted for 

selection in the recent past since slight errors in these have the potential to change the 

compensation decision from non-compensated to compensated. Thus almost one-third of the case 

reviews (30%) since the 2009 Secretary’s Report have been in the POC range of 45 to <50 

percent. This is a major increase in reviews in this POC range, compared to only 5% of reviews 

in this range during the first 100 case reviews reported in 2009. This reflects both the increased 

percentage of best-estimate cases reviewed since 2009 and our more fine-tuned focus on assuring 

correct compensation decisions. 

Another subgroup, those cases with POC from 50-52%, have also been targeted recently along 

with the 45 to <50% group. For the subgroup from 50-52% the DRSC wants to assure that small 

over-estimation errors in this subgroup has not resulted in erroneous compensation decisions. 

While as a matter of agency policy when such errors are found the claimant is not asked to return 

his/her compensation money, finding such overestimation errors can help both the Board and 

associated staff avoid such compensation errors in the future. Even with this focus, however, the 

percentage of reviews in this report (21%) which have POC at or over 50% is less than the 

corresponding value of 27% in the 2009 Report. This reflects a sharp decline in over-estimation 

cases since 2009. Similarly the percentage of cases reviewed with POC below 45% has declined 

from 68% before 2009 to 49% in this report, in this instance reflecting a decline in underestimation reviews since 2009. The bottom line in both of these instances is that the Board is 

now more clearly focused on reviewing cases for which small errors in radiation dose can change 

the compensation decision, and hence on assuring that the final compensation decision is correct, 

based on the data collected for each individual claimant’s exposure. 
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Blind Reviews 

To further assure the accuracy of claimants’ dose reconstructions and hence POCs, the Board 

adopted a policy in 2012 of soliciting blind reviews in a limited number cases – that is, tasking 

the NIOSH/ORAU and SC&A teams independently to conduct and compare dose 

reconstructions and POCs for these selected cases and have them reviewed by the Dose 

Reconstruction Reviews Subcommittee. While this process is resource-intensive it is the best, 

most appropriate way to check the consistency and precision of the program’s dose 

reconstruction assessments and their derived PoCs. During the past two years, the program has 

solicited six blind review cases per year, and plans to do so again in 2016.So far fourteen cases 

have been reviewed using thus process, and 13 are in agreement with respect to their 

compensation decisions, while the resolution of one case (#3) remains under discussion by the 

DRSC [and will be resolved at the Feb 10 DRSC meeting. discussion. (Table 4) This is quite 

good agreement given the selection of cases which needed best-estimate assessments (typically 

resulting in PoCs in the 45-52 percent range), the complexities of these dose reconstruction 

Table 4. Blind Case Reviews

Blind Case No. (Facility) POC by SC&A POC by NIOSH/ORAU

A. First contract period

1. Portsmouth Gas Diffusion 49.35% 48.75%

2. X-10 48.00% 43.63%

B. Set 17 Blinds

3. Allied Chemical 85.40% 45.90%

4. Fernald 38.12% 48.27%

5. Hanford 43.18% 45.27%

6. Rocky Flats 42.65% 47.51%

7. Savannah River 51.00% 51.39%

8. Y-12 and X-10 50.47% 50.46%

C. Set 20 Blinds

9. Nevada Test Site 40.59% 41.17%

10. Hanford/Weldon Springs Plant 40.71% 42.49%

11. Hanford/Pacific NW Natl. Lab. 36.43% 42.31%

12. Rocky Flats 43.78% 42.91%

13. Brookhaven Natl. Lab. 51.05% 52.54%

14. Y-12 49.48% 49.46%
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calculations and the absence of extensive internal and external dose measurements for many 

individuals. 

For the 14 cases in Table 4 the median of the absolute value of the difference between POCs = 

ǀPOC(SC&A) – POC(NIOSH/ORAU)ǀ = 1.6%. The average value of these absolute differences 

= 5.2%. Even excluding the one outlier case (#3) the median is essentially unchanged at 1. 

8% as expected and the average value is halved to 2.5%. While these figures give pause for cases 

in which PoCs are near 50%, it should be noted that these case were chosen from among those 

which needed best-estimate DRs, that is with PoCs expected to be in the 45-52% dose range – 

and 10 of these 14 were -- and that in all cases but one both blind assessments were either above 

or below the 50% and hence agreed on compensability. (NOTE: To be modified after completed 

dose reconstructions for the remaining case (in red) by SC&A.) 

Distribution of Dose Reconstruction Reviews by Years of Employment

Figure 4 (Copy Figure 8 from revised Summary Statistics, Rose Gogliatti, SC&A, January 7, 

2016.) shows the distribution of dose reconstructions by years of employment. As noted twothirds (67%) of those for whom doses were reconstructed and reviewed by the DRSC worked in 

EEOICPA-covered facilities for 20 years or more, 13% for 10 to 20 years and 20% for less than 

10 years (median 30.9 years). 

The present results (Cases 101-334) reflect a slight average increase in years of employment 

compared to those reported in the first Secretary’s Report at 53% for 20 years or more, 21% for 

10 to 20 years and 26% for less than 10 years, respectively (median 21.2 years). This is not 

surprising since the current report has been developed six years after the first, allowing more 

years of employment by claimants before developing cancers and/or applying for claims. Also in 

the ensuing years since the first Secretary’s Report the trends 5-year relative survival rates of 

cancer victims has continued to rise, allowing claimants more years of employment before they 

file their claims if they so choose. Consistent with these observations the estimated median 

values of these two sets of dose reconstruction data developed through 2009 and 2015 differ by 

about 10 years – 21.2 years versus 30.9 years.
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Distribution of Cases Reviewed by Risk Model 

Figure 5 (Copy Figure 9 from revised Summary Statistics, Rose Gogliatti, SC&A, January 7, 

2016.) presents the breakdown by type for 28 cancers in Cases 101-334. The types with the 

largest numbers of cases evaluated are Non-melanoma Skin (BCC and SCC) (63 cases), All 

Male Genitalia (47 cases), Lung (45 cases), and Urinary Tract (36 cases), of which half are 

cancers of the bladder and the other half urinary tract excluding the bladder. These results are 

similar in distribution to those reviewed for Cases 1-100. 

Distribution of Cases Reviewed by Decade First Employed

Figure 6 (Copy Figure 6 from revised Summary Statistics, Rose Gogliatti, SC&A, January 7, 

2016.) presents the distribution of Cases 101-334 by decade first employed. Fully 72 percent of 

the cases reviewed were first employed before 1960: 49 percent were from the 1950s, 21 percent 

from the 1940s and even 2% from the 1930s. As expected given the decades-long latency periods 

of most cancers, these percentages decline in more recent decades from 18% in the 1960s to 6% 

in the 1970s and 4% in the 1980s. None were reviewed in this cohort from the 1990s or later. 

Comparing these results with those from the 2009 Secretary’s Report, there is now a large 

increase in the percentage of claims reviewed from before 1960 (72%) compared to 51% in the 

earlier report. This appears to reflect both the increases in cancer incidence rates with age and 

years of exposures and in filing of claims as the 1940s/1950s cohort reached retirement ages.